Treatment of Infantile Eczema

First-Line Treatment

The British Medical Journal recommends the use of mild to moderate potency topical corticosteroids as first-line therapy for infantile eczema, with careful consideration of potency based on severity and affected body areas 1, 2
Emollients are essential for maintaining skin hydration and should be applied regularly, especially after bathing when the skin is still damp, as recommended by the British Medical Journal 1, 3
The American Academy of Dermatology suggests avoiding irritants such as soaps, detergents, and wool clothing that can exacerbate eczema, and instead recommends cotton clothing as it is more comfortable and less irritating 3
Keeping nails short to minimize damage from scratching is also recommended by the British Medical Journal 3

The British Medical Journal advises using the least potent preparation required to control the eczema 1
For infants, mild to moderate potency corticosteroids are preferred due to their high body surface area-to-volume ratio, which increases risk of systemic absorption, according to the Journal of the American Academy of Dermatology 4
Application frequency: apply once or twice daily as directed by the British Medical Journal 1
The Journal of the American Academy of Dermatology recommends avoiding high-potency or ultra-high-potency corticosteroids in infants due to increased risk of hypothalamic-pituitary-adrenal (HPA) axis suppression 4

The Journal of Microbiology, Immunology and Infection suggests that tacrolimus 0.03% ointment and pimecrolimus 1% cream are effective alternatives for sensitive areas such as the face and genital regions 5
Pimecrolimus is FDA-approved for children as young as 3 months of age, according to the Journal of Microbiology, Immunology and Infection 5

Secondary bacterial infection (usually Staphylococcus aureus) requires antibiotic treatment, with flucloxacillin as the first choice for S. aureus infections, as recommended by the British Medical Journal 1
Eczema herpeticum (herpes simplex infection) requires prompt treatment with oral acyclovir, according to the British Medical Journal 1

Sedating antihistamines may be useful as short-term adjuncts during severe itching episodes, as suggested by the British Medical Journal 1
Non-sedating antihistamines have little value in atopic eczema, according to the British Medical Journal 1

The risk of adverse effects increases with higher potency, occlusion, and prolonged use of topical corticosteroids, as noted by the Journal of the American Academy of Dermatology 4
Parents should receive clear instructions on the amount of medication to apply, safe sites for application, and duration of treatment, as recommended by the Journal of the American Academy of Dermatology 4
Avoid abrupt discontinuation of high-potency corticosteroids to prevent rebound flares, according to the Journal of the American Academy of Dermatology 4